A Modified Technique of Tacking Acellular Dermal Matrix to Increase Keratinized Mucosa Around Dental Implants as an Alternative to a Free Gingival Graft: A Case Report.

INTRODUCTION: Free autogenous graft was the gold standard to increase the keratinized mucosa (KM) and vestibular depth. The major downfall of this technique is the postoperative morbidity at the donor site. The purpose of this case report is to demonstrate a modified technique using acellular dermal matrix (ADM) to increase the KM around implants to achieve faster healing with less postoperative morbidity. CASE PRESENTATION: Patient presented with inadequate keratinized tissue band and shallow vestibule at submerged implant sites bilaterally. Initially, surgical procedure of vestibuloplasty in conjunction with free gingival graft (FGG) was performed at one side. However, patient opted for the allograft as a substitute for the other side due to the postoperative discomfort from palatal donor site. On the left side, the FGG procedure was performed in a conventional way stabilizing with sutures. On the right side, the ADM was stabilized with tacks only at recipient site and left exposed. The new vestibule was established and stabilized with tacks.  A significant gain of KM and vestibule depth was observed at the site of using ADM when compared with baseline. For the site of using FGG, KM was increased. However, the vestibule was rebounded compared with the site of using ADM with tacks. CONCLUSIONS: The use of ADM stabilized with tacks is a predictable procedure that can increase KM and establish stable vestibule around dental implants. It can lead to less chair time, faster healing, and reduced postoperative morbidity compared with autogenous soft tissue graft.

Maxillary Sinus Grafting With Biphasic Bone Ceramic or Autogenous Bone: Clinical, Histologic, and Histomorphometric Results From a Randomized Controlled Clinical Trial.

PURPOSE: The present, randomized, controlled clinical trial compared the histologic and histomorphometric results from maxillary sinus augmentation with either biphasic calcium phosphate (BCP) (60% hydroxyapatite and 40% ß-tricalcium phosphate) or autogenous bone (AB) as bone-grafting materials. MATERIAL AND METHODS: Ten patients received bilateral sinus elevation surgery with intraoral AB chips (control group) on one side and BCP (test group) on the contralateral side. After a healing period of 6 to 8 months, implant sites were created and trephine cores were harvested for histological and histomorphometric analysis of the grafted areas. RESULTS: The histological examination of biopsies showed BCP particles interconnected by bridges of a vital newly formed bone. Histomorphometry demonstrated that the amount of newly formed bone in the control group (36.8%) was significantly greater than that in the BCP (28.2%) group (P = 0.0032). BCP and AB cores revealed an average of residual graft particles of 32.9% and 4.8%, respectively. The average percentage of soft tissue components was 38.9% in the BCP cores and 58.4% in the AB cores. CONCLUSIONS: Based on our findings, the amount of vital bone formation was significantly higher for AB than that for BCP. However, BCP seemed to be a biocompatible and osteoconductive material that can be used with success as a bone substitute in maxillary sinus procedures.

Clinical and Histological Evaluation of Ceramic Matrix in a Collagen Carrier for Socket Preservation in Humans.

INTRODUCTION: A case series was used to evaluate the efficacy and predictability of a ceramic matrix in a putty-like collagen carrier in immediate extraction sockets. METHODS: A single failing tooth was atraumatically extracted from each of 10 subjects. The sockets were debrided and grafted with ceramic matrix in a putty-like collagen carrier (15% hydroxyapatite, 85% ß-tricalcium phosphate complex). A bovine pericardium membrane was draped over the graft site and a tension-free primary closure was obtained. After 6 months of healing, a trephine biopsy was taken from the center of each graft and a dental implant was placed. Two subjects were withdrawn from the study and were considered treatment failures. One of them moved to another state and the second exhibited delayed healing that required debridement of the grafting material from the socket. RESULTS: After 6 months follow-up, there was a mean reduction of ridge width of 1.667 mm and mean reduction of ridge height of 0.483 mm after graft healing and integration. Over a 24-month follow-up, mean new bone fill was 40.25% and implant osseointegration was 100%. CONCLUSION: Ceramic matrix in a putty-like collagen carrier maintained ridge dimensions and, despite ongoing bone turnover, produced adequate mineralized tissue that enabled implant placement at 6 months.

Demineralized bone matrix in extraction sockets: a clinical and histologic case series.

PURPOSE: To evaluate its efficacy and predictability in immediate extraction sockets, this case series used demineralized bone matrix in a puttylike carrier (DBM putty) with and without mineralized bone chips. Each preparation was made from the long bones of the same tissue donor; the only excipient material was water. MATERIAL AND METHODS: A single failing tooth was atraumatically extracted from each study subject, and the socket was debrided. Intact sockets were grafted with DBM putty (n = 6), and sockets with buccal defects were grafted with DBM putty with bone chips (n = 6). A bovine pericardium membrane was draped over the graft site, and tension-free primary closure was obtained. After 6 months of healing, a trephine biopsy was taken from the center of each graft, and then, a dental implant was placed. Two subjects were withdrawn, and histologic data could not be obtained from 2 other patients. RESULTS: Mean new bone fill was 40.28% for DBM putty (n = 5) and 44.60% for DBM putty with bone chips (n = 4). CONCLUSIONS: Both preparations maintained ridge dimensions and, despite ongoing bone turnover, produced adequate mineralized tissue that enabled implant placement at 6 months. This finding warrants further research.

Immediate placement and provisionalization of implant-supported, single-tooth restorations: a retrospective study.

Immediate implant placement into extraction sockets has been widely reported in the dental literature, but few studies have evaluated immediate loading of such implants. This retrospective study evaluated 206 implants placed into fresh extraction sites using a flapless technique, followed by immediate provisionalization with nonoccluding single-tooth restorations and definitive restoration within 2 weeks. Cumulative survival and success rates were 98.77% (mean follow-up, 23.1 months). Periodontitis did not influence the outcome adversely. Within the limitations of this study, immediate implant placement and restoration, followed by definitive loading within 2 weeks, achieved outcomes comparable to those historically reported for delayed implants.

Soft tissue closure of grafted extraction sockets in the posterior maxilla: the rotated pedicle palatal connective tissue flap technique.

The sequelae of socket collapse and localized ridge resorption after tooth extraction in the posterior maxilla can adversely affect esthetics, function, and future implant placement. Immediate grafting of extraction sockets may help to preserve natural ridge contours; but lack of available soft tissue can prevent primary closure or exert tension that hampers graft turnover and compromises the visible gingival scallop. Exposed barrier membranes may also be susceptible to bacterial infection that may lead to secondary graft failure. The rotated pedicle palatal connective tissue flap is a relatively simple technique for soft tissue coverage of grafted sockets without excessive tension. This article presents the technique.

Regeneration of an osseous peri-implantitis lesion.

This case report concerns the loss of osseous tissue around two hydroxyapatite (HA) Biovent implants, placed in 1993, at sites #30 and #31. The implant in site #31 was positioned with a distal angle, resulting in an ill-fitting prosthesis. This permitted bacterial colonization to set up a periimplantitis. The rough HA coating on the implants further exacerbated the resultant bone loss. In an attempt to rectify the pathology, surgical debridement, antibiotic therapy, bone grafting, and guided tissue regeneration with a barrier membrane were utilized. This case report documents a successful partial repair of osseous housing around these implants.